Provider Demographics
NPI:1073617759
Name:WISHART, JILL ANNE RUBIN (LCSW DCSW)
Entity Type:Individual
Prefix:MRS
First Name:JILL ANNE
Middle Name:RUBIN
Last Name:WISHART
Suffix:
Gender:F
Credentials:LCSW DCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9054
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:TN
Mailing Address - Zip Code:37615-9054
Mailing Address - Country:US
Mailing Address - Phone:423-467-3600
Mailing Address - Fax:423-467-3696
Practice Address - Street 1:26 MIDWAY ST
Practice Address - Street 2:BRISTOL REGIONAL COUNSELING CENTER
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620
Practice Address - Country:US
Practice Address - Phone:423-989-4500
Practice Address - Fax:423-989-4582
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW0000003204104100000X
VA0904003737104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
253893OtherANTHEM PROF TRIGON
3048466OtherMAGELLAN SUMMIT
334969OtherVALUEOPTIONS GROUP
253893OtherANTHEM PREF TRIGON
099634OtherVALUEOPTIONS
1051419OtherCIGNA MCC
39725OtherUBH JOHN DEERE
39725OtherUBH SENIOR
3048466OtherMAGELLAN EAP
3048466OtherMAGELLAN NAVIGATOR
39725OtherUBH HEALTHPLAN
39725OtherUBH EMPLOYER
3048466OtherMAGELLAN PINNACLE
3048466OtherMAGELLAN SUMMIT
3048466OtherMAGELLAN PINNACLE